类风湿关节炎甲状腺功能状况分析

Clinical analysis of thyroid function status in patients with rheumatoid arthritis

目的研究类风湿关节炎(RA)患者伴发甲状腺功能异常的情况及临床意义。方法采用病例对照研究,纳入200例RA患者为RA组,100例健康体检者为对照组。检测甲状腺功能、抗甲状腺抗体、免疫学指标、常规实验室检查项目,评估RA疾病活动度(DAS28评分)。对RA患者甲状腺功能状况进行分析。比较两组甲状腺功能及抗甲状腺抗体的差异。对甲状腺功能正常与异常RA患者的自身抗体、常规实验室检查项目、DAS28评分进行组间比较和相关性分析。结果 RA组甲状腺功能异常30例(15%),高于对照组7例(7%),两组差异有统计学意义(P<0.05)。其中甲状腺功能减低10例,亚临床型甲减6例,低T3/T4综合征9例,甲状腺功能亢进3例,亚临床型甲状腺功能亢进2例。RA组游离三碘甲状腺原氨酸降低,促甲状腺素、抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体增高,较对照组差异有统计学意义(P<0.05)。RA组甲状腺功能异常与血红蛋白浓度(HGB)、胆固醇(TC)有相关性。结论 RA患者易出现甲状腺功能异常,以甲状腺功能减低最常见。RA伴发甲状腺功能异常与HGB、TC有相关性。

Objective To investigate the complicating thyriod dysfunction situation in the patients with rheumatiod arthritis（RA）and its clinical significance.Methods The case-control study was adopted.Two hundreds cases of RA were included into the RA group and 100 individuals undergoing the physical examination served as the control group.The thyroid function,anti-thyroid antibodies,immunological markers and routine laboratory test items were measured.The RA disease activity score（DAS28）was used to assess the disease activity.The thyriod function status of RA patients were analyzed.The difference in thyroid function and anti-thyroid antibodies were compared between the two groups.The autoantibodies,routine laboratory test items and DAS28 score in the RA patients with normal thyroid function and the RA patients with abnormal thyroid function were performed the inter-group comparison and correlation analysis.Results Thirty cases（15%）in the RA group had abnormal thyroid function,which was higher than 7cases（7%）in the control group,the difference between the two groups were statistically significant（P〈0.05）.Among them,10 cases were hypothyroidism,6cases were sub-clinical type hypothyroidism 9cases were lo0 w T3/T4 syndrome,3cases were hyperthyroidism and 2cases were sub-clinical type hyperthyroidism.FT3 in the RA group was decreased,while TSH,TPOAb and TGAb were increased,the difference with the control group was statistically significant（P〈0.05）.The thyroid function abnormality in the RA group had the correlation with HGB and TC.Conclusion RA patients are likely to develop thyroid dysfunction,especially hypothyroidism is most common.RA complicating thyroid function abnormality is correlated with HGB and TC.The levels of HGB and TC have correlations with thyroid dysfunction in RA.